Olecranon Osteotomy Fixation Following Distal Humerus Open Reduction and Internal Fixation: Clinical Results of Plate and Screws Versus Tension Band Wiring.

Olecranon osteotomy allows for improved visualization of the distal humeral articular surface. This study compared the clinical outcomes of 2 methods of olecranon repair following olecranon osteotomy as part of distal humerus fracture repair. This was a retrospective review of distal humerus fractures treated via a transolecranon approach during a 9-year period. In each case, the olecranon osteotomy was fixed with either tension band wiring (TBW) or plate fixation (PF). Patient demographics, injury information, and surgical management were recorded. Measured outcomes included elbow motion, time to osteotomy union, and postoperative complications. Mayo Elbow Performance Index (MEPI) scores were obtained for all patients. Forty-eight patients were included. All patients had intra-articular AO type 13-C2 or 13-C3 distal humerus fractures and underwent open reduction and internal fixation (ORIF) with olecranon osteotomy. Mean documented follow-up was 20.5 months. Twenty-seven patients had fixation of the olecranon osteotomy with TBW, and 21 with PF. Clinically, there were no differences in osteotomy time to union, elbow motion, or MEPI score at final follow-up. However, patients fixed with TBW had greater elbow extension at both 6-month and final follow-up. Complication rates did not differ. Patients undergoing TBW or PF for repair of an olecranon osteotomy following ORIF of intra-articular distal humerus fractures have similar outcomes. Patients undergoing osteotomy PF may experience less terminal elbow extension when compared with those fixed with TBW. Given their similar clinical outcomes, either modality may be considered when selecting a construct for olecranon osteotomy repair as part of comminuted distal humerus fracture repair. [Orthopedics. 2021;44(1):e107-e113.].